Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IODOFORM PACKING STRIP 1"

Facility

$30.15

Service Code	NDC 8080783300
Hospital Charge Code	6063943114
Hospital Revenue Code	270
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

IODOFORM PACKING STRIP 1"

Facility

$30.15

Service Code	NDC 8080783300
Hospital Charge Code	6063943114
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

IODOFORM PACKING STRIP 1/2"

Facility

$25.66

Service Code	NDC 8080783200
Hospital Charge Code	6063943115
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$12.83
Rate for Payer: Aetna Commercial	$9.75
Rate for Payer: Aetna Medicare Advantage	$7.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.54
Rate for Payer: Cigna Commercial	$12.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.67
Rate for Payer: Oxford Commercial	$5.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.85
Rate for Payer: UnitedHealthcare Commercial	$5.13
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

IODOFORM PACKING STRIP 1/2"

Facility

$25.66

Service Code	NDC 8080783200
Hospital Charge Code	6063943115
Hospital Revenue Code	270
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$3.85

IODOFORM PACKING STRIP 1/4"

Facility

$25.80

Service Code	NDC 8080783100
Hospital Charge Code	6063943116
Hospital Revenue Code	270
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.87

IODOFORM PACKING STRIP 1/4"

Facility

$25.80

Service Code	NDC 8080783100
Hospital Charge Code	6063943116
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna Commercial	$9.80
Rate for Payer: Aetna Medicare Advantage	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.58
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.71
Rate for Payer: Oxford Commercial	$5.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.87
Rate for Payer: UnitedHealthcare Commercial	$5.16
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

IO EXPAND INTERB SYS 10X22MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698134
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$15,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

IO EXPAND INTERB SYS 10X22MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.00
Max. Negotiated Rate	$31,250.00
Rate for Payer: Aetna Commercial	$23,750.00
Rate for Payer: Aetna Medicare Advantage	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,937.50
Rate for Payer: Cigna Commercial	$31,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00
Rate for Payer: UnitedHealthcare Community & State	$1,975.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,775.00

IO EXPAND INTERB SYS 10X26MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698135
Hospital Revenue Code	278
Min. Negotiated Rate	$9,375.00
Max. Negotiated Rate	$15,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00

IO EXPAND INTERB SYS 10X26MM L

Facility

$62,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270698135
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.00
Max. Negotiated Rate	$31,250.00
Rate for Payer: Aetna Commercial	$23,750.00
Rate for Payer: Aetna Medicare Advantage	$18,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,937.50
Rate for Payer: Cigna Commercial	$31,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,375.00
Rate for Payer: UnitedHealthcare Community & State	$1,975.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,775.00

IOHEXOL 240 MG SOL

Facility

$350.08

Service Code	NDC 407141230
Hospital Charge Code	60627878
Hospital Revenue Code	255
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.04
Rate for Payer: Aetna Commercial	$133.03
Rate for Payer: Aetna Medicare Advantage	$105.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.27
Rate for Payer: Cigna Commercial	$175.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.02
Rate for Payer: Oxford Commercial	$70.02
Rate for Payer: Qualcare PPO/HMO/WC	$52.51
Rate for Payer: UnitedHealthcare Commercial	$70.02
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

IOHEXOL 240 MG SOL

Facility

$350.08

Service Code	NDC 407141230
Hospital Charge Code	60627878
Hospital Revenue Code	255
Min. Negotiated Rate	$52.51
Max. Negotiated Rate	$52.51
Rate for Payer: Qualcare PPO/HMO/WC	$52.51

IOHEXOL 300 100 ML

Facility

$751.00

Service Code	NDC 407141363
Hospital Charge Code	6063943209
Hospital Revenue Code	255
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$375.50
Rate for Payer: Aetna Commercial	$285.38
Rate for Payer: Aetna Medicare Advantage	$225.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.50
Rate for Payer: Cigna Commercial	$375.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.26
Rate for Payer: Oxford Commercial	$150.20
Rate for Payer: Qualcare PPO/HMO/WC	$112.65
Rate for Payer: UnitedHealthcare Commercial	$150.20
Rate for Payer: UnitedHealthcare Community & State	$23.73
Rate for Payer: Wellpoint Medicaid Managed Care	$21.33

IOHEXOL 300 100 ML

Facility

$751.00

Service Code	NDC 407141363
Hospital Charge Code	6063943209
Hospital Revenue Code	255
Min. Negotiated Rate	$112.65
Max. Negotiated Rate	$112.65
Rate for Payer: Qualcare PPO/HMO/WC	$112.65

IOHEXOL 300 50 ML

Facility

$383.31

Service Code	NDC 407141361
Hospital Charge Code	6063943211
Hospital Revenue Code	255
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.50

IOHEXOL 300 50 ML

Facility

$383.31

Service Code	NDC 407141361
Hospital Charge Code	6063943211
Hospital Revenue Code	255
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$191.66
Rate for Payer: Aetna Commercial	$145.66
Rate for Payer: Aetna Medicare Advantage	$114.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.74
Rate for Payer: Cigna Commercial	$191.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.66
Rate for Payer: Oxford Commercial	$76.66
Rate for Payer: Qualcare PPO/HMO/WC	$57.50
Rate for Payer: UnitedHealthcare Commercial	$76.66
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

IOHEXOL 300ML/30ML

Facility

$229.94

Service Code	NDC 407141361
Hospital Charge Code	606390584
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$114.97
Rate for Payer: Aetna Commercial	$87.38
Rate for Payer: Aetna Medicare Advantage	$68.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.63
Rate for Payer: Cigna Commercial	$114.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.78
Rate for Payer: Oxford Commercial	$45.99
Rate for Payer: Qualcare PPO/HMO/WC	$34.49
Rate for Payer: UnitedHealthcare Commercial	$45.99
Rate for Payer: UnitedHealthcare Community & State	$7.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

IOHEXOL 300ML/30ML

Facility

$229.94

Service Code	NDC 407141361
Hospital Charge Code	606390584
Hospital Revenue Code	250
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$34.49
Rate for Payer: Qualcare PPO/HMO/WC	$34.49

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
Hospital Revenue Code	276
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
Hospital Revenue Code	276
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$251.06
Max. Negotiated Rate	$405.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: Qualcare PPO/HMO/WC	$251.06

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$47.53
Max. Negotiated Rate	$836.85
Rate for Payer: Aetna Commercial	$636.01
Rate for Payer: Aetna Medicare Advantage	$502.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.79
Rate for Payer: Cigna Commercial	$836.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: Qualcare PPO/HMO/WC	$251.06
Rate for Payer: UnitedHealthcare Community & State	$52.89
Rate for Payer: Wellpoint Medicaid Managed Care	$47.53

IOL ACRYSOFT RES-SN60D3/SN6AD3

Facility

$861.00

Hospital Charge Code	270339005
Hospital Revenue Code	276
Min. Negotiated Rate	$129.15
Max. Negotiated Rate	$208.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.36
Rate for Payer: Qualcare PPO/HMO/WC	$129.15

Know your out-of-pocket cost for care.

All Charges